Voriconazole Side Effects and Monitoring

Common and Serious Side Effects

Transient visual disturbances, including photopsia, blurred vision, changes in color perception, and photophobia, occur in approximately 30% of patients, according to the Infectious Diseases Society of America 1
Hepatic injury, manifested as elevated serum bilirubin, alkaline phosphatase, and hepatic aminotransferase enzyme levels, may be dose-limiting, as recommended by the Clinical Infectious Diseases guidelines 1
Tachyarrhythmias and QT interval prolongation on electrocardiography are well-documented, with rare cases of ventricular arrhythmias, including torsade de pointes, bradycardia, cardiac arrest, and sudden death, as reported by the American Heart Association 1
Prolonged voriconazole therapy significantly increases the risk of cutaneous malignancies, primarily squamous cell carcinoma (SCC), which is duration-dependent and associated with more aggressive and multifocal malignancies, according to the National Comprehensive Cancer Network 1
Voriconazole is the only triazole requiring dosage reduction for mild to moderate hepatic impairment, as recommended by the European Association for the Study of the Liver 2, 3
Intravenous voriconazole is complexed to cyclodextrin, which accumulates in renal insufficiency and poses a potential nephrotoxicity risk, according to the National Kidney Foundation 2, 3
Oral voriconazole does not require dosage adjustment for renal insufficiency, as stated by the American Society of Nephrology 2, 3

Measurement of serum voriconazole levels is useful in the majority of patients to evaluate for potential toxicity and document adequate drug exposure, as recommended by the Infectious Diseases Society of America 1
Toxicity is more common with higher drug levels, and careful monitoring is essential for safe drug use, according to the Clinical Infectious Diseases guidelines 1
Common polymorphisms in CYP2C19 result in wide variability of serum levels between patients, as reported by the American Society for Clinical Pharmacology and Therapeutics 2, 3
Drug interactions are common with voriconazole and must be considered when initiating and discontinuing treatment, as recommended by the American Society of Health-System Pharmacists 2, 3
The potential for drug-drug interactions is high and requires careful attention to dosage regimens and monitoring, according to the European Association of Hospital Pharmacists 1